Breast Cancer

DESCRIPTION AND TYPES

Ductal carcinoma is the most common form of breast cancer. Tumors form in the cells of the milk ducts, which convey milk to the nipples. Ductal carcinoma can either be invasive, with the potential to spread, or non-invasive.

Lobular carcinoma occurs in the lobules, which are the milk-producing glands. Lobular carcinoma can be invasive, with a tendency to spread, or non-invasive.

Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer that affects the dermal lymphatic system. Rather than forming a lump, IBC tumors grow in flat sheets that cannot be felt in a breast exam.

Recurrent breast cancer means that the cancer has returned after being undetected for a time. Recurrent cancer can occur in the remaining breast tissue, and also at other sites such as the lungs, liver, bones or brain. Even though these tumors are in a new location, they are still called breast cancer.

Symptoms of breast cancer may vary from woman to woman. Women should be familiar with their breasts so that they know what feels and looks normal for them. Changes should be promptly reported to a health care provider. Many cancers are found by regular mammography after age 40 – before any symptoms are felt.

Symptoms include:

Lump or mass in your breast

Enlarged lymph nodes in the armpit

Changes in breast size, shape, skin texture or color

Skin redness

Dimpling or puckering

Nipple changes or discharge

Scaliness

Nipple pulling to one side or a change in direction

Many breast changes – including lumps – are not cancer, but if you notice one or more of these symptoms for more than two weeks, see your doctor.

...AND MD ANDERSON

From the moment a patient is diagnosed as a result of a suspicious image from her ultrasound or mammogram, a multidisciplinary team discusses the case to make recommendations on which diagnostic tests and treatment procedures the specific patient needs in accordance with the stage of her disease.

The committee evaluating the case is made up of: Surgery, Radiation Therapy, Medical Oncology, Radiation Oncology, Anatomical Pathology, Plastic Surgery and a Clincal Trials team. Each patient receives recommedations on the best procedure in accordance with the guidelines and standards in Houston.

PREVENTION

Risk Factors

Many factors may influence the development of breast cancer, including:

Age. Most cases occur in women 50 or older; it is less common in women 35 or younger. Age is the most influential risk factor.

Family history. Your risk is higher with a family history (especially mother, sister, daughter) of breast and/or ovarian cancer.

Hormones / childbirth. Your risk is higher if you had your first period before age 12, began menopause after age 55, never had children or had your first child after age 30. Postmenopausal use of hormonal therapy increases your risk of developing breast cancer.

Previous biopsy. If you’ve had abnormal breast biopsy results or benign breast diseases requiring biopsies, you may be at increased risk. Other breast diseases such as atypical hyperplasia, lobular or ductal carcinoma in situ are risk factors, too.

Education / socioeconomic status. Women with a higher socioeconomic status and/or education tend to have fewer children and start childbearing after age 30 – both of which put them at higher risk.

Weight. Obesity or weight gain after menopause are risk factors.

Genetic alterations. Inherited susceptibility genes BRCA1 and BRCA2 account for about five to 10% of all breast cancer cases.

Other risk factors include:

Oral contraceptive use

A diet high in saturated fats

Physical inactivity

Alcohol (more than one alcoholic drink a day)

Screening Tests

Breast cancer screening tests are performed on healthy women with no symptoms on a regular basis. Regular screening exams help catch cancer in its early stages, when it is much more likely to respond to treatment. Typical breast screening exams include:

Clinical breast exam: your physician will visually examine your breasts and manipulate them manually to feel for lumps or other breast changes. Clinical breast exams should be performed every one to three years beginning at age 20, and every year beginning at age 40.

Mammogram: Each breast is placed between two photographic plates and compressed, while an X-ray is taken of the breast tissue. Mammograms should be conducted every year beginning at age 40 and possibly earlier if a woman has certain risk factors such as inherited genetic mutations.

In addition to the screening exams above, women should also practice breast “self-awareness.” Becoming familiar with your breasts makes it much more likely that you will notice changes that may signal cancer or another health condition.

DIAGNOSIS

There are several procedures that can be used to diagnose breast cancer. Not every procedure will be done for each patient. The evaluation is based upon the patient’s examination and physician recommendations.

Biopsy: a small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies can be done in the following ways:

Surgical biopsy: an incision is made in the breast. Surgeons locate the tumor by palpation or with the aid of images from a CT scan, ultrasound or mammogram. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, only a portion of the tumor is removed.

Fine Needle Aspiration (FNA): a thin, hollow needle is inserted into the breast to the tumor, and fluid and cells are removed from the tumor. While this test can help to determine if there is cancer present, it cannot determine if the cancer is invasive and additional biopsies may be needed if cancer is actually present.

Core biopsy: a thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor.

Diagnostic mammogram: this procedure is similar to the mammogram used for screening, but provides more detailed images of the breast tissue.

Ultrasound: a special wand placed against the skin transmits sound waves, which bounce off breast tissue and are used create an image on a monitor.

Sentinel lymph nodebiopsy: lymph nodes are olive-sized glands which are part of a system that circulates lymph fluid throughout the body. The lymphatic system can also carry cancer cells from the tumor site to other areas of the body. In breast cancer patients, the first nodes to be affected are under the arm.

In a sentinel lymph nodebiopsy, a radioactive tracer is injected into the area before surgery. Then, the surgeon injects a blue dye near the tumor site, which shows up in cancerous lymph nodes. The node with the highest amount of tracer or blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye. This procedure can spare healthy lymph nodes, which results in fewer side-effects such as lymphedema.

Staging

(Source: National Cancer Institute)

The staging system allows doctors to help identify the extent of breast cancer involvement. By knowing the extent of disease, doctors can then determine the best treatment for each patient.

Stage 0 (carcinoma in situ): cancer has not spread from the site of origin.

Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.

Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.

Stage I: Cancer has formed. The tumor is 2 centimeters or smaller and has not spread outside the breast.

Stage IIA

No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or

The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or

The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB

The tumor is larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or

The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA

No tumor is found in the breast. Cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or

The tumor is 2 centimeters or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or

The tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or

The tumor is larger than 5 centimeters. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.

In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone.

Stage IV: The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

TREAT

Surgery

Surgery is the most common treatment for breast cancer. Surgery to remove one or both breasts is called mastectomy. The entire breast is removed, along with any affected lymph nodes. In about 80% of mastectomies, breast reconstruction or implant surgery is performed during the same procedure, after the breast is removed.

Breast-sparing surgery is an attempt to save as much healthy breast tissue as possible. These procedures are best for treating early stage (I & II) tumors. Breast-sparing techniques include:

Lumpectomy: the tumor and a small margin of healthy breast tissue are removed.

Partial mastectomy: the tumor is removed, along with a margin of healthy breast tissue, the lining of the chest muscles, and any affected lymph nodes under the arm.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. There are two types of radiation treatment for breast cancer:

External beam radiation: the beams are aimed at the tumor from outside the body. Patients undergo radiation five days a week for a certain number of weeks.

Internal radiation: tiny plastic tubes filled with radioactive material are implanted in the breast at the tumor site and are removed after several days. This procedure requires a hospital stay.

Women who have undergone breast-sparing surgery and/or mastectomy may receive radiation afterwards to kill any lingering cancer cells. Radiation can also be used before surgery to shrink large tumors or to treat tumors in a difficult location.

The following technological means and types of radiation therapy are used with this disease:

Chemotherapy is the use of drugs, either alone or in combination, to kill cancer cells. In breast cancer, chemotherapy is most often used either before or after surgery, or as a primary treatment for cancer that has spread outside the breast at the time of diagnosis.

Hormone Therapy

Hormone therapy is used to prevent female hormones (estrogen, progesterone and estradiol) from fueling the growth of breast tumors in some patients. Hormone therapy can involve taking drugs, either by mouth or through an IV. Tamoxifen is an example of a hormone therapy drug. Surgery to remove the ovaries in women who have not yet reached menopause is another type of hormone therapy.

Biologic Therapy

Biologic therapy is a drug treatment that helps the body’s immune system fight cancer.

SUPPORT

Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, support is available. Listed below are just some of the ways to find help and hope.

Support Groups

Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support Web sites or message boards for those who may not have access to a traditional meeting.

Complementary Therapies

Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, Tai Chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture.

Physical Activity

Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.

Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.

Journaling/Blogging

Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers.

Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own Web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.

At the vanguard of R+D+i

Research is one of the mainstays of the MD Anderson Cancer Center Madrid. The center increases its research activity every year and to date, more than 500 patients have taken part in some sort of clinical trial.

Affiliate of Houston

In the year 2000, the MD Anderson Cancer Center Madrid opened its doors as the only affiliate of The University of Texas MD Anderson Cancer Center in Houston, one of the world’s most prestigious oncology centers.